Clinic: Various other jellyfishes causing stings in humans
A wide range of jellyfish is relatively harmless with the exception of life-threatening immediate-type hypersensitivity reactions in sensitized individuals. It seems to be rare, however (see below; see Tibballs et al. 2011, Togias et al. 1985).
The jellyfish which are responsible for the majority of lifethreatening envenoming and fatal outcome are
There is, however, a multitude of species for which reliable data are missing, both epidemiological and clinical, which could cause significant including life threaenting envenoming. It can be difficult or even impossible to distinguish between anaphylactic shock and toxin-related cardiopulmonary failure.
E.g., apart from Caraukia barnesi, other carybdeid jellyfish may cause Irukandji syndrome (Gershwin et al 2013: “Table 1.2 Summary of ecology and syndrome characteristics of species known or believed to cause Irukandji syndrome”; Tibballs et al 2012; Debate: Little et al 2006, Gershwin 2006, Fenner 2006): Alatina mordens, Carukia shinju, Carybdea alata, Carybdea rastonii, Carybdea xaymacana, Malo maxima, Malo kingi, Alatina mordens, Gerongia rifkinae and Morbakka fenneri.
Cnidarian venoms are (thermo-)labile. At body temperature they lose their activity. Thus, a patient may still be rescued with sustained resuscitation efforts.
Prevention: Avoidance of further stings has been suggested. If complete avoidance is found an unacceptable restriction, 'stinger suits' and carrying adrenaline for self-injection may be an option (Stein et al. 1989).
Seasonal, local 'epidemics' of jellyfish occur; e.g. Pelagia noctiluca (see below) in the Mediterranean Sea affects millions of bathers each year. Stings are at the beginning very painful which can persist for several days. Signs and symptoms can recur several times for weeks after the inital sting.
Observations in a wide range of jellyfishes (exemplary)
Aurelia sp.
Israel (Mediterranean)
Benmeir et al. 1990: 1 sting. Identification: attributed to A. aurita.
Burnett et al. 1988b: 1 sting. Identification: attributed to A. aurita; ELISA: Aurelia sp.
Carybdea sp.
Carybdea marsupialis
Italy (Adriatic)
Kokelj et al. 1992: 1 C. marsupialis sting. Identification: self-stinging experiment.
Carybdea rastoni
Japan
Ohtaki et al. 1990: 25 C. rastoni stings. Exposure of experimental subjects to C. rastoni tentacles.
Chrysaora sp.
Burnett et al. 1987b: 3 Chrysaora sp. stings. Identification: immunological.
Chrysaora quinquecirrha
USA (Virginia, Chesapeake Bay)
Glasser et al. 1992: corneal sting.
Cyanea sp.
Cyanea annaskala
Australia
Mitchell 1962: 4 C. annaskala eye stings. Identification: mass occurrence of these jellyfish in a bay during the swimming season.
Cyanea capillata
Australia
Fenner and Fitzpatrick 1986: self-stinging experiments.
USA (Virginia, Chesapeake Bay)
Rice and Powell 1972: 35 C. capillata stings. Exposure of experimental subjects to C. capillata tentacles.
Gonionemus sp.
Gonionemus oshoro
Japan
Otsuru et al. 1974: 5 G. oshoro stings. Exposure of experimental subjects; additionally countless observations of stings in bathers and people gathering seagrass.
Linuche unguiculata (larvae)
USA (Florida)
Tomchik et al. 1993: observations that link "seabather's eruption" or "sea lice" to contact with the larvae of L. unguiculata.
"Morbakka"
Morbakka fenneri?, Tamoya virulenta?
Australia
Fenner et al. 1985: 1 sting. Identification: morphological.
Pelagia sp.
Pelagia noctiluca
Italy (Adriatic)
Kokelj and Burnett 1990: 1 sting. Identification: attributed to P. noctiluca.
Former Yugoslavia (Adriatic)
Maretic et al. 1980: Description of an epidemic in the Adriatic with 250,000 jellyfish stings (estimated).
Stomolophus sp.
China
Mingliang and Shide 1990: 3,000 Stomolophus sp. stings. Identification: criteria not given.
Stomolophus meleagris
USA (North Carolina)
Burnett and Calton 1985: 1 S. meleagris sting. Identification: recognition from photographs; ELISA.
Aurelia aurita, Chrysaora hysoscella, Rhizostoma pulmo
Italy (Adriatic)
Kokelj et al. 1990: 25 stings with each of three purified nematocyst preparations (Aurelia aurita, Chrysaora hysoscella, Rhizostoma pulmo). Exposure of experimental subjects.
Signs & symptoms
allergic / Autopharmacological effects
In principle all jellyfish stings can cause systemic allergic reactions, including anaphylactic shock after sensitisation by previous stings (Togias et al. 1985). Sensitisation does not necessarily have to have occurred with the same species that causes the anaphylactic reaction.
Gonionemus oshoro
Nausea, vomiting, rhinitis, cough, hyperlacrimation, anaphylactic shock causing death (Otsuru et al. 1974).
Linuche unguiculata (larvae)
Instantaneous pain and urticarial skin symptoms after the sting are positively correlated with prior exposure (sensitisation?). Nausea, vomiting, headache, fever (particularly in children) (Tomchik et al. 1993).
Pelagia noctiluca
Persistent pruritus (>1 week); nausea, vomiting, syncope (Maretic et al. 1980).
Local effects
Aurelia sp.
Burning pain commencing immediately and lasting for 2 days, swelling in the region of the sting for 2 weeks (Benmeir et al. 1990). Immediate local pain, piloerection, urticaria, ulceration (Burnett et al. 1988b). Pruritus after 20 min, erythema after 48 h (Kokelj et al. 1990).
Carybdea marsupialis
Burning pain, erythema (Kokelj et al. 1992).
Carybdea rastoni
Severe pain starting within 1 min after the sting and lasting for 10 min–8 h. Erythema with a pale centre; onset within 3–4 min after the sting, increasing over a period of 15–20 min. Disappearance of the erythema within 24 h–3 days (Ohtaki et al. 1990) (see also "Morbidity").
Chrysaora hysoscella
Erythema after 48 h (Kokelj et al. 1990).
Chrysaora sp.
Local burning pain, local erythema (Burnett et al. 1987b).
Chrysaora quinquecirrha
Corneal sting: severe, persistent iritis and increased intra-ocular pressure, the patients first consulted a doctor after >24 h because the symptoms occurred with some delay (normally symptoms caused by this sort of sting are self-limiting within 24–48 h) (Glasser et al. 1992).
Cyanea annaskala
Eye sting with immediate pain, photophobia, blepharospasm, conjunctival and ciliary injection and superficial to deep corneal lesions (4/4); duration of signs and symptoms 2–7 days (Mitchell 1962).
Cyanea capillata
Very mildly painful, marked erythema (Fenner and Fitzpatrick 1986). In more than half of the stung individuals no local reaction, in less than half mild local tingling, in a few mild erythema (Rice and Powell 1972).
Gonionemus oshoro
Immediate local pain, local erythema (Otsuru et al. 1974).
Linuche unguiculata (larvae)
Pain and urticarial skin symptoms and in children in particular nausea, vomiting, headache, fever 4–24 h after exposure (Tomchik et al. 1993).
"Morbakka" (Morbakka fenneri?, Tamoya virulenta?)
Local, burning pain, duration approx. 24 hours, local erythema with a pale centre, later papulovesicular skin lesions (Fenner et al. 1985).
Pelagia noctiluca
Immediate and sometimes sharp pain, followed by severe pruritus. Papulae with surrounding erythema. Lesions may be arranged linearly. Blistering (Maretic et al. 1980). Recurrent lesions (Mansson et al. 1985).
Rhizostoma pulmo
Pruritus within 20 min, erythema after 48 h (Kokelj et al. 1990).
Stomolophus meleagris
Immediate burning pain, linear erythema (Burnett and Calton 1985) (see also "Morbidity").
Tamoya sp.
Severe local pain, welt-like skin lesions, erythema (Williamson 1985).
Other signs & symptoms
Gonionemus oshoro
Muscular pain (Otsuru et al. 1974), symptoms similar to those of the "Irukandji syndrome", compare Carukia barnesi.
"Morbakka" (Morbakka fenneri?, Tamoya virulenta?)
Back pain, onset approx. 30 min after the sting, duration approx. 24 h (Fenner et al. 1985), symptoms similar to those of the "Irukandji syndrome", Fenner 1991, compare Carukia barnesi.
Stomolophus sp. (e.g. Stomolophus nomurai)
"Irukandji-like" syndrome with rapidly progressive pulmonary oedema (Mingliang and Shide 1990), compare Carukia barnesi.
Tamoya sp.
Muscular pain (Williamson 1985), symptoms similar to those of the "Irukandji syndrome", Fenner 1991, compare Carukia barnesi.
Morbidity
Carybdea rastoni
7–13 days after the sting linear erythema and papulovesicular skin lesions with pruritus, duration approx. 1 week, leaves mild pigmentation, histological picture that of allergic contact dermatitis (Ohtaki et al. 1990).
Chrysaora sp.
Recurrent skin signs and symptoms (Burnett et al. 1987b).
Chrysaora quinquecirrha
Chronic unilateral glaucoma following eye sting, see above (Glasser et al. 1992).
Linuche unguiculata (larvae)
Recurrence of skin symptoms after 5–10 days (Tomchik et al. 1993).
Pelagia noctiluca
Hyperpigmentation (Kokelj and Burnett 1990, Maretic et al. 1980). Recurrent skin signs and symptoms (Mansson et al. 1985).
Stomolophus meleagris
Recurrent skin lesion after 7 days (Burnett and Calton 1985).
Case fatality rate
Gonionemus oshoro
Fatalities have been reported and attributed to severe anaphylactic reactions after repeat exposure (Otsuru et al. 1974).
Stomolophus sp. (e.g. Stomolophus nomurai)
5/3,000 (Mingliang and Shide 1990).
Laboratory and physical investigations
ELISA
Within a few days after the sting, specific IgG antibodies are formed that persist for many months. The species of jellyfish that caused the sting can be identified retrospectively using antibody detection with an ELISA test. However, there are problems with specificity (Burnett et al. 1988a).
First aid
Supportive Treatment
Pain
A multitide of remedies has been suggested and are in use. The majority lacks formal assessment of effectiveness, however.
Systemic effects of the venom which are significant or reminscent of
consult these clinical entries and
Clinical management: Cnidarians
Treatment (specific)
Antivenom: not available.